| NPI | 1780362053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND 201142) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R39912) |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2024-12-10 |